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This document provides information on medications including insulin lispro and warfarin. It includes details like generic and brand names, dosages, routes of administration, pharmacokinetics, indications, contraindications and monitoring parameters. High alerts are listed for both insulin and warfarin due to risks of hypoglycemia, allergic reactions and bleeding. Assessment of blood glucose, signs of bleeding and monitoring of coagulation factors are recommended for the medications.
This document provides information on medications including insulin lispro and warfarin. It includes details like generic and brand names, dosages, routes of administration, pharmacokinetics, indications, contraindications and monitoring parameters. High alerts are listed for both insulin and warfarin due to risks of hypoglycemia, allergic reactions and bleeding. Assessment of blood glucose, signs of bleeding and monitoring of coagulation factors are recommended for the medications.
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This document provides information on medications including insulin lispro and warfarin. It includes details like generic and brand names, dosages, routes of administration, pharmacokinetics, indications, contraindications and monitoring parameters. High alerts are listed for both insulin and warfarin due to risks of hypoglycemia, allergic reactions and bleeding. Assessment of blood glucose, signs of bleeding and monitoring of coagulation factors are recommended for the medications.
Drepturi de autor:
Attribution Non-Commercial (BY-NC)
Formate disponibile
Descărcați ca DOCX, PDF, TXT sau citiți online pe Scribd
lnsullns (8apld AcLlng) lnsulln Llspro runA orgln/Pumalog Gener|c Name]8rand Name Warfarln (warfarln)/Coumadln Dose] koute] Irequency Crdered L Speclflc Is th|s route appropr|ate for pat|ent? ?es /no Dose] koute] Irequency Crdered L Speclflc Is th|s route appropr|ate for pat|ent? ?es /no n|gh A|ert? es ]No Why? Lrrors can resulL ln pL harm and deaLh Clarlfy orders uo noL accepL orders uslng u for unlLs lnsullns are avallable ln dlfferenL Lypes and sLrengLhs Check Lype dose and exp daLe wlLh anoLher nurse uo noL lnLerchange lnsullns wlLhouL consulLlng physlclan or oLher healLh care professlonals n|gh A|ert? es ]No Why? Lrrors lnvolvlng anLlcoagulanLs can resulL ln serlous harm or deaLh from lnLernal or lnLracranlal bleedlng 8efore admlnlsLerlng evaluaLe recenL ln8 or 1 resulLs and have second pracLlcloner lndependanLly check orlglnal order 8ecause of Lhe larger number of medlcaLlons capable of slgnlflcanLly alLerlng warfarlns effecLs careful monlLorlng ls recommended when new agenLs are sLarLed or oLher agenLs are dlsconLlnued lnLeracLlve poLenLlal should be evaluaLed for all new medlcaLlons (8x C1C and naLural producLs) C|ass|f|cat|on (1herapeut|c]harmaco|og|c) AnLldlabeLlcs Pormones/ancreaLlcs C|ass|f|cat|on (1herapeut|c]harmaco|og|c) AnLlcoagulanLs/Coumarlns Act|on (therapeut|c effect) ConLrol of hyperglycemla ln dlabeLlc paLlenLs Act|on (therapeut|c effect) revenLlon of Lhromboembollc evenLs Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon) ConLrol of hyperglycemla ln paLlenLs wlLh Lype 1 or Lype 2 dlabeLes melllLus Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon) rophylaxls and LreaLmenL of venous Lhrombosls ulmonary embollsm ALrlal flbrlllaLlon wlLh embollzaLlon ManagemenL of myocardlal lnfarcLlon uecreases rlsk of deaLh uecreases rlsk of subsequenL Ml uecreases rlsk of fuLure Lhromboembollc evenLs revenLlon of Lhrombus formaLlon and embollzaLlon afLer prosLheLlc valve placemenL nome Med|cat|on es ]No If yes dose change? (rev|ous dose t|me)
nome Med|cat|on es ]No If yes dose change? (rev|ous dose t|me)
(8elow) harmacoklneLlcs 3672 hrs 37 days (aL a consLanL dose) 23 days (afLer dlsconLlnuaLlon) Llver harmacok|net|cs (onset peak durat|on metabo||sm) wlLhln 13 mln 113 hrs 34 hrs Llver spleen kldney and muscle harmacok|net|cs (onset peak durat|on metabo||sm) 1extbook Dose kange (for ordered route and |nd|cat|on) L Speclflc 1extbook Dose kange (for ordered route and |nd|cat|on) C 23 mg/day for 24 days Lhen ad[usL dally dose by resulLs of ln8 lnlLlaLe Lherapy wlLh lower doses ln gerlaLrlc pL or deblllLaLed pL or ln Aslan pL or Lhose wlLh C?2C9*3 alleles or vkC8C1 AA genoLype Contra|nd|cat|ons]Caut|ous use Pypoglycemla allergy or hypersenslLlvlLy Lo a parLlcular Lype of lnsulln preservaLlves or oLher addlLlves/SLress Contra|nd|cat|ons]Caut|ous use unconLrolled bleedlng Cpen wounds AcLlve ulcer dlsease 8ecenL braln eye or splnal cord ln[ury or surgery Severe and lnfecLlon 8enal/PepaLlc dysfuncLlon llver or kldney dlsease unconLrolled hyperLenslon/Mallgnancy L wlLh hlsLory of ulcer or llver dlsease PlsLory of poor compllance Women wlLh chlldbearlng poLenLlal Adverse keact|on Common
Severe Pypoglycemla and Anaphylaxls
1ox|c|ty s|gns]Cverdose Ant|dote? Pypoglycemla Mlld hypoglycemla may be LreaLed by lngesLlon of oral glucose Severe hypoglycemla ls a llfe LhreaLenlng emergency LreaLmenL conslsLs of lv glucose glucagon or eplnepherlne Larly slgns of hypoglycemla may be less pronounced by long duraLlon dlabeLes dlabeLlc nerve dlsease and use of beLa blockers may resulL ln loss of consclousness prlor Lo pL awareness of hypoglycemla Adverse keact|on Common
Severe 8leedlng
1ox|c|ty s|gns]Cverdose Ant|dote? WlLhholdlng 1 or more doses of warfarln ls usually sufflclenL lf ln8 ls excesslvely elevaLed or lf mlnor bleedlng occurs lf overdose occurs or anLlcoagulaLlon needs Lo be lmmedlaLely reversed Lhe anLldoLe ls vl1AMln k (phyLonadlone AquaMLP?1Cn) AdmlnlsLraLlon of whole blood or plasma also may be requlred ln severe bleedlng because of Lhe delayed onseL of vlLamln k Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food) arentera| (compat|b|||ty d||ut|on requ|red and rate) SubC May be mlxed wlLh nP lnsulln Mlxed lnsullns should never be used as lv or pump AdmlnlsLer wlLh 13 mln before or lmmedlaLely afLer sLarLlng a meal Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food) arentera| (compat|b|||ty d||ut|on requ|red and rate) AdmlnlsLer aL same Llme each day C MedlcaLlon requlres 33 days Lo reach effecLlve levels usually begun whlle pL ls sLlll on heparln uo noL lnLerchange brands poLencles may noL be equlvalenL ulrecL lv 8econsLlLuLe each 3mg vlal wlLh 27 mL of sLerlle waLer for ln[ecLlon 8econsLlLuLed soluLlon ls sLable for 4 hr aL room Lemp ulluLenL no furLher dlluLlon needed before ConcenLraLlon 2 mg/mL 8aLe AdmlnlsLer over 12 mln Assessment needed (pre dur|ng and post) Assess sympLoms of hypglycemla (anxleLy resLlessness Llngllng ln hands feeL llps or Longue chllls cold sweaLs confuslon cool pale skln dlfflculLy ln concenLraLlon drowslness nlghLmares or Lrouble sleeplng excesslve hunger P/A lrrlLablllLy nausea nervousness Lachycardla Lremor weakness unsLeady galL) and Pyperglycemla (confuslon drowslness flushed dry skln frulLllke breaLh odor rapld deep breaLhlng polyurla loss of appreLlLe nausea vomlLlng unusual LhlrsL) MonlLor body welghL Asses for slgns of allerglc reacLlons MonlLor blood glucose q6h durlng Lherapy Assessment needed (pre dur|ng and post) Assess for slgns of bleedlng and hemorrhage (bleedlng gums nosebleed unusual brulslng Larry black sLools hemaLurla fall ln hemaLocrlL or blood pressure gualac poslLlve sLools urlne or nasogasLrlc asplraLe) Assess for evldence of addlLlonal or lncreased Lhrombosls MonlLor 1 ln8 and oLher cloLLlng facLors frequenLly durlng Lherapy MonlLor hepaLlc funcLlon and C8C before and perlodlcally LhroughouL Lherapy MonlLor sLool and urlne for occulL blood before and perlodlcally durlng Lherapy keference(s) uavls urug Culde 721 keference(s) uavls urug Culde 1293
Medicotion worksheet lo//2011 Gener|c Name]8rand Name Peparlns (Low Molecular WelghL) Lnoxaparln (enoxaparln)/Lovenox Gener|c Name]8rand Name
Dose] koute] Irequency Crdered L Speclflc Is th|s route appropr|ate for pat|ent? ?es /no Dose] koute] Irequency Crdered
Is th|s route appropr|ate for pat|ent? ?es /no n|gh A|ert? es ]No Why? unlnLended concomlLanL use of Lwo heparln producLs (unfracLlonaLed heparln and LMW heparlns) has resulLed ln serlous harm and deaLh 8evlew pL recenL and currenL med admlnlsLraLlon records before admlnlsLerlng any heparln or LMW heparln prodcuL n|gh A|ert? es ]No Why? C|ass|f|cat|on (1herapeut|c]harmaco|og|c) AnLlcoagulanLs/AnLlLhromboLlcs C|ass|f|cat|on (1herapeut|c]harmaco|og|c)
Act|on (therapeut|c effect) revenLlon of Lhrombus formaLlon Act|on (therapeut|c effect)
Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon) 1x of acLue S1segmenLelevaLlon Ml (wlLh LhrombolyLlcs or percuLaneous coronary lnLervenLlon) Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon)
nome Med|cat|on es ]No If yes dose change? (rev|ous dose t|me)
nome Med|cat|on es ]No If yes dose change? (rev|ous dose t|me)
harmacok|net|cs (onset peak durat|on metabo||sm) unknown 33 hrs 12 hrs rlmarlly 8enally harmacok|net|cs (onset peak durat|on metabo||sm) 1extbook Dose kange (for ordered route and |nd|cat|on) lv SubcuL (AdulLs 73 yr) AdmlnlsLer slngle lv bolus of 30 mg plus 1 mg/kg subcuL dose (max of 100 mg for flrsL 2 doses only) followed by 1 mg/kg subcuL q 12 hr 1he usual duraLlon of 1x ls 28 days ln pL undergolng percuLaneous coronary lnLervenLlon lf lasL subcuL dose was 8 hr before balloon lnflaLlon no addlLlonal doslng needed lf lasL subcuL does was or equal Lo 8 hr before balloon lnflaLlon admlnlsLer slngle lv bolus of 03 mg/kg SubcuL (AdulLs 73 yr) 073 mg/kg every 12 hr (no lv bolus needed) (max of 73 mg for flrsL 2 doses only no lnLlLlal bolus) 1he ususaly duraLlon of 1x ls 28 day
1extbook Dose kange (for ordered route and |nd|cat|on)
Contra|nd|cat|ons]Caut|ous use PypersenslLlvlLy Lo speclflc agenLs or pork producLs cross senslLlvlLy may occur Some producLs conLaln sulflLes or benzyl alcohol and should be avolded ln pL wlLh known hypersenslLlvlLy or lnLolerance AcLlve ma[or bleedlng PlsLory of heparlnlnduced LhrombocyLopenla Contra|nd|cat|ons]Caut|ous use
Adverse keact|on Common Anemla
Severe 8leedlng
1ox|c|ty s|gns]Cverdose Ant|dote? roLamlne SulfaLe 1 mg for each mg of Lovenox should be admlnlsLered by slow lv ln[ecLlon Adverse keact|on Common
Severe
1ox|c|ty s|gns]Cverdose Ant|dote?
Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food) arentera| (compat|b|||ty d||ut|on requ|red and rate) CannoL be used lnLerchangeably (unlL for unlL) wlLh unfracLlonaLed heparln or oLher LMW heparlns SubcuL AdmlnlsLer deep lnLo subcuL Llssue 8oLaLe slLes frequenLly LefL Lo rlghL of upper and lower abdomen SoluLlon should be clear lf excesslve brulslng occurs lce cube message of slLe before admlnlsLraLlon may lessen brulslng 1o avold Lhe loss of drug do noL expel Lhe alr bubble from Lhe syrlnge before Lhe ln[ecLlon ulrecL lv use mulLldose vlal for bolus ln[ecLlons AdmlnlsLer Lhrough a preexlsLlng lv llne llush llne wlLh 09 naCl or u3W before and afLer admlnlsLraLlon Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food) arentera| (compat|b|||ty d||ut|on requ|red and rate)
Assessment needed (pre dur|ng and post) Assess for slgns of bleedlng and hemorrhage (bleedlng gums nosebleeds unusual brulslng black Larry sLools hemaLurla fall ln hemaLocrlL or blood pressure gualac poslLlve sLools) bleedlng from surglcal slLe noLlfy healLh care professlonal lf Lhese occur Assess for evldence of addlLlonal or lncreased Lhrombosls MonlLor neurologlcal sLaLus MonlLor for hypersenslLlvlLy reacLlons Cbserve ln[ecLlon slLes for hemaLomas ecchymosls or lnflammaLlon MonLlor C8C plaLeleL counL and sLools for occulL blood perlodlcally durlng Lherapy Assessment needed (pre dur|ng and post)